2nd try - lab help
OK, OK, OK, OK - I admit it. The vets are right. Don't listen to anything your surgeon's office says about nutrition post-op.
Listed below are my pre and post-op labs and normal ranges. Anything out of range is in red. I bought the surgeon's office advice to start with their plan and adjust according to my labs. Now my labs have gone to **** and I'm not going to follow their advice anymore. Currently I am taking 3 Bariatric Advantage ADEK (1 pill 3 times a day); 2400 mg calcium (2 of Vitalady's calcium 4 times a day), 60 mg Vitalady iron (with 1000 mg generic C, once daily, by itself). My question - Should I switch to Vitalady's program or something more aggressive? For nutrition I use 2 shakes (2 scoops each, total of 80-90 g protein) each day. The rest of the day I eat mostly eggs, cheese, meat, nuts and a few veggies. My total protein is usually about 120 g. Once in a while I'll eat a bit of bread or crackers, but I really try to limit the carbs. Should I add another shake? I'm 5 months out from surgery; DS surgery was 3/28. I've lost 71 lbs and have 54 lbs to go to goal.
Listed below are my pre and post-op labs and normal ranges. Anything out of range is in red. I bought the surgeon's office advice to start with their plan and adjust according to my labs. Now my labs have gone to **** and I'm not going to follow their advice anymore. Currently I am taking 3 Bariatric Advantage ADEK (1 pill 3 times a day); 2400 mg calcium (2 of Vitalady's calcium 4 times a day), 60 mg Vitalady iron (with 1000 mg generic C, once daily, by itself). My question - Should I switch to Vitalady's program or something more aggressive? For nutrition I use 2 shakes (2 scoops each, total of 80-90 g protein) each day. The rest of the day I eat mostly eggs, cheese, meat, nuts and a few veggies. My total protein is usually about 120 g. Once in a while I'll eat a bit of bread or crackers, but I really try to limit the carbs. Should I add another shake? I'm 5 months out from surgery; DS surgery was 3/28. I've lost 71 lbs and have 54 lbs to go to goal.
Reference Range | Pre-Op | Date | Post-Op | Date | |||
Low | High | Units | 11/4/2010 | 3/8/2011 | 7/2/2011 | 8/26/2011 | |
Metabolic Panel | |||||||
Glucose | 65 | 99 | mg/dL | 85 | 105 | 81 | 83 |
HA1c | 6.5 | % of hemo | |||||
Urea Nitrogen (BUN) | 7 | 25 | mg/dL | 14 | 16 | 16 | 16 |
Creatinine | 0.59 | 1.07 | mg/dL | 0.9 | 0.78 | 0.78 | 0.77 |
eGFR | >60 | >60 | 89 | 91 | |||
sodium | 135 | 146 | mmol/L | 138 | 137 | 139 | 139 |
potasium | 3.5 | 5.3 | mmol/L | 3.9 | 3.9 | 3.4 | 3.7 |
chloride | 98 | 110 | mmol/L | 103 | 104 | 106 | 107 |
carbon dioxide | 21 | 33 | mmol/L | 24 | 29 | 23 | 26 |
calcium | 8.6 | 10.2 | mg/dL | 9.5 | 9.8 | 8.9 | 8.9 |
calcium, ionized | 4.8 | 5.6 | mg/dL | 5.1 | |||
PTH, intact | 10 | 65 | mg/dL | 45 | 90 | ||
protein, total | 6.2 | 8.3 | g/dL | 7.2 | 6.4 | 6.2 | |
albumin | 3.6 | 5.1 | g/dL | 4.5 | 4.1 | 4.1 | |
globulin | 2.2 | 3.9 | g/dL | 2.7 | 2.3 | 2.1 | |
albumin/globulin ratio | 1 | 2.1 | 1.7 | 1.8 | 2 | ||
bilirubin, total | 0.2 | 1.2 | mg/dL | 0.6 | 0.6 | 0.8 | |
bilirubin, direct |
I give up on trying to paste in my spreadsheet. Here's the rest of my labs that are now out of range or changed a great deal:
lab range pre-op post-op
vit D, 25 OH total 30-100 41 22
RBC 3.8-5.1 4.01 3.17
hemoglobin 11.7-15.1 13.1 10.3
hematocrit 35-45 38.7 30.8
RDW 11-15 11.5 15.4
cholesterol, total 125-200 162 94
HDL >45 66 42
LDL
I don't see your vitamin levels. How is your D? Alkaline Phosphatase? Since your protein seems to be trending down, yeah, I would add another protein shake. PTH is high. So we need to see where your D is at. How much total elemental calcium are your taking a day? Are your taking magnesium citrate and K2? Those help with calcium absorption too.
Bonnie.. you're going to find that it's going to take a little while to get your labs back up, I hope you are feeling more or less ok.
You mention supplimenting Iron, do you know what your hematocrit/hemoglobin is at? If you're feeling tired and or cold a lot this could be part of the issue. I take 3 60mg (it's 325mg, but only 60 is elemental) in the morning AND at night. Taking it with vitamin C is good. Also remember don't take it with any other medications or vitamins (except possibly copper) for an hour before/after you eat otherwise it won't be absorbed well at all.
It's good you're stepping up your suppliments, I was told 2 multivitamins and 4 tums a day by my surgeons office. Wrong.
Justin
Edit: I see the rest of your labs now. Get some 50k IU DRY D3 from Vitalady, I think she's got a summer sale ending soon on it. People will tell you 40 is the bare minimum, but 80 is good. If you're at 22 chances are most of the calcium you're supplimenting isn't doing you much good.
You mention supplimenting Iron, do you know what your hematocrit/hemoglobin is at? If you're feeling tired and or cold a lot this could be part of the issue. I take 3 60mg (it's 325mg, but only 60 is elemental) in the morning AND at night. Taking it with vitamin C is good. Also remember don't take it with any other medications or vitamins (except possibly copper) for an hour before/after you eat otherwise it won't be absorbed well at all.
It's good you're stepping up your suppliments, I was told 2 multivitamins and 4 tums a day by my surgeons office. Wrong.
Justin
Edit: I see the rest of your labs now. Get some 50k IU DRY D3 from Vitalady, I think she's got a summer sale ending soon on it. People will tell you 40 is the bare minimum, but 80 is good. If you're at 22 chances are most of the calcium you're supplimenting isn't doing you much good.
When the heck are surgeons going to figure out that we need more than an ADEK???? Grrrrrr.......then they stop doing the DS because of supposed deficiencies, when all they have to do is prescribe enough D from the get-go. Did they test your zinc or your A? We come up short on those, and they are all linked. Get yourself on 50 k of dry D a day, and that's for starters. I can't help you much with the iron issues, as I am infused.
In my experience, my protein was pretty wonky for a while, then it righted. My D and calcium issues though, do not seem to want to go away.
In my experience, my protein was pretty wonky for a while, then it righted. My D and calcium issues though, do not seem to want to go away.
Julie R - Ludington, Michigan
Duodenal Switch 08/09/06 - Dr. Paul Kemmeter, Grand Rapids, Michigan
HW: 282 - 5'4"
SW: 268
GW: 135
CW: 125
Duodenal Switch 08/09/06 - Dr. Paul Kemmeter, Grand Rapids, Michigan
HW: 282 - 5'4"
SW: 268
GW: 135
CW: 125